Provider Demographics
NPI:1386005502
Name:BRIGHT FUTURE STEM ED. SERVICES INC (DBA-BRIGHT FUTURE HEALTHCENTER
Entity Type:Organization
Organization Name:BRIGHT FUTURE STEM ED. SERVICES INC (DBA-BRIGHT FUTURE HEALTHCENTER
Other - Org Name:LAKE HEALTH SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR AND PROGRAM COORDINATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOLOCHINYERE
Authorized Official - Middle Name:FIDELIA
Authorized Official - Last Name:NNAJIOFOR
Authorized Official - Suffix:
Authorized Official - Credentials:PROGRAM COORDINATOR/
Authorized Official - Phone:956-570-1763
Mailing Address - Street 1:3100 PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-9395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3100 PROVIDENCE AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-9395
Practice Address - Country:US
Practice Address - Phone:956-570-1763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIGHT FUTURE STEM ED SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-16
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2083P0901X, 320900000X, 373H00000X
251B00000X, 302R00000X, 320600000X, 320700000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty